PEDIATRICS Vol. 108 No. 2 August 2001, pp. 297-304
Effect of the Vaccines for Children Program on Physician Referral of Children to Public Vaccine Clinics: A Pre-Post Comparison
Received Sep 6, 2000; accepted Nov 30, 2000.
,,
From the Department of * Family Medicine and Clinical
Epidemiology, School of Medicine and Objective. Started in late 1994, the
Vaccines for Children (VFC) program is a major entitlement program that
provides states with free vaccines for disadvantaged children. Some
evaluation studies have been conducted, but they do not include
individually matched pre-post comparisons of physician responses. This
project studied the effect of the VFC on the physician likelihood of
referring children to public vaccine clinics for immunizations.
Design. In 1999, trained personnel conducted a survey of a
cohort of physicians who previously participated in surveys on barriers to childhood vaccination conducted before VFC implementation. Responses
were matched, and pre- versus post-VFC comparisons were made.
Setting and Participants. Minnesota and Pennsylvania
primary care physicians selected by stratified random sampling and
initially studied in 1990 to 1991 and 1993, respectively.
Main Outcome Measures. Likelihood of referral of a child
to a public vaccine clinic.
Results. On a scale of 0 to 10, physician likelihood of
referring an uninsured child decreased by a mean of 1.9 (95%
confidence interval: 1.2-2.5) from pre- to post-VFC. Two fifths (45%)
of physicians reported that the VFC decreased the number of referrals
from their practice to public vaccine clinics and 50% gave
intermediate responses. Among physicians who participate in VFC, only
9% were likely to refer a Medicaid-insured child in contrast to 44%
of those not participating.
Conclusions. Physicians' reported referral and likelihood
of referring Medicaid-insured and uninsured children has decreased
because of VFC in Minnesota and Pennsylvania.vaccination/economics, vaccination/legislation and jurisprudence,
immunization programs/economics, immunization programs/utilization, vaccines/economics, Medicaid/economics, national
health programs United States, child health services.
Health Services Administration,
Graduate School of Public Health, University of Pittsburgh, Pittsburgh,
Pennsylvania; and § Health Services Research and Evaluation Branch,
Immunization Services Division, National Immunization Program, Centers
for Disease Control and Prevention.
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